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By Jennifer Garvin

If dental professionals have ever been concerned about possible exposure to HIV-positive patients or if they have questions about treating HIV-positive patients in the dental setting, then they may want to take advantage of the Warmline and Post-Exposure Prophylaxis Hotline run by the National HIV/AIDS Clinicians' Consultation Center.

Although the hotlines have been around since 1991 and have logged more than 90,000 calls, the San Francisco-based NCCC would like to get the word out so that more dental professionals will begin taking advantage of the free and confidential service. Currently, less than 3 percent of all calls received are from dentists, dental hygienists, dental assistants and other dental professionals. Of that 3 percent, two-thirds of the calls are from dental assistants and hygienists.

"One of the reasons that there aren't more calls is that our profession isn't aware of the service," says Dr. Stephen Abel, dental director of the New York/New Jersey AIDS Education and Training Centers and associate professor of oral medicine at the Nova Southeastern University College of Dental Medicine. "This is a valuable service. Solo or rural practitioners do not always have immediate access to experts in the management of PEP or they may not know whether PEP is indicated. Being able to pick up the phone and know someone will be there to immediately answer (their) questions is invaluable."

Most of the NCCC's dental calls deal with exposure to blood from an instrument or needlestick. The most immediate benefit of the hotlines is that they provide immediate expert triage and counseling to a caller dealing with occupational exposure as well as give dental professionals access to local resources that can help.

"If nothing else, we can decrease a lot of fear in a lot of people," says Ron Goldschmidt, M.D., director of the NCCC and cofounder of the hotlines with Julie Gerberding, M.D., now head of the CDC. "We know there's a need. We just need to reach more of the dental community. We can be a valuable resource to whoever's in charge of the dental office as to what the next steps might be after an exposure."

The 24-hour PEPline is the national resource on occupational needlesticks and splashes and is for health professionals who think they may have been exposed to HIV or other bloodborne pathogens. The Warmline provides advice on HIV clinical and drug information for any health care provider. (See insert between pages 16 and 17, this issue.)

"It's been incredibly gratifying work because we know how much help we're giving," Dr. Goldschmidt said. "In many cases what we're doing is just providing reassurance and alleviating their fears and we consider that a really important part of what we do. Many times dental professionals don't know where to get help and we think we can help fill that void."

According to Dr. Goldschmidt, these are some questions dental professionals should consider if they think they have been exposed:

• Was this an exposure of importance? Dr. Goldschmidt says, "In dentistry, most of the hollow-bore needles are very tiny and used more for injection. They seem to be less likely to be prone to passing infection than the larger bore needles that are used to draw blood or provide IV. Nevertheless, all needles and other instruments that can similarly puncture the skin can be a potential source of transmission."
• Does the source patient have HIV? How do you find out? Most dental practices are not set up to evaluate a patient's HIV status. PEPline consultants may advise dental professionals who are concerned about a possible exposure to visit the nearest emergency room, which, depending on legal constrictions, can often follow up with source patients to determine their HIV status.
• Is prophylaxis with antiretroviral drugs appropriate? If so, what drugs and for how long? The PEPline will advise callers on how to provide and where to find proper treatment.

"When these episodes happen, the range of human experience runs the gamut," Dr. Goldschmidt says, "from denial to panic and back again, and often in the same person."